Storm Closing – Hurricane Dorian

Due to the expected impact of Hurricane Dorian, offices of Retina of Coastal Carolina will not operate on Thursday, September 5 or Friday, September 6. Any emergency calls should be placed to our main number (910) 254-2023 and will be routed to our answering service. The physician on call will respond in a timely manner.

Meet Out New Clinic Supervisor

CONGRATULATIONS KELSEY!

Kelsey was promoted to Clinic Supervisor this summer as her predecessor re-located out of state. Kelsey has been an important part of the clinical team at Retina of Coastal Carolina since 2013. While continuing to serve patients off and on the clinical floor, Kelsey is taking on more responsibilities as she joins the management team.
In recognition of her performance and her connection with patients and staff, Kelsey was our most recent ‘pink flamingo’.

Thanks Kelsey for all you do!

After 21 Years…

Dr. Erik van Rens is retiring from Retina of Coastal Carolina. Joining our practice in year 2, he will be greatly missed by patients and staff. We wish him many more years to enjoy his hobbies, children and grandchildren.

 

We zullen je missen!

THANKS

In late April we were glad to recognize our administrative staff at a lunch in their honor. These are the individuals you speak with on the phone, the smiling faces at our front desk and those folks who try to translate ‘insurance speak’ into plain English the rest of us understand.

This month we will show our appreciation to our clinic staff. These folks are responsible for the screening and testing before you see the physician, trying to keep pace with entering into the electronic health record system what the doctor is saying and assisting with in office procedures. Many also arrive to our main location early in the morning, traveling with the physician to one of our 3 satellite locations, often making it a 10 or 11 hour day. Without their commitment and efforts, our physicians would not be able to provide the level of care we are proud to offer at ROCC.
Thanks to all our staff members. As a now retired employee was fond of saying, “Team Work Makes the Dream Work!”

Yellow Post-It with Thanks You! written on it

WE GOTTA GO WHERE IT’S WARM…


Just in time for the streak of unseasonably warm February weather,
the ROCC office took on the look of the tropics.

Staff wearing colorful Hawaiian leis

With a background of beach balls, palm leaves and scenes of warm, sunny tropical beaches,
staff enjoyed a lunch of burgers with all the fixins, chips, salads and of course dessert!

Staff eating oustside

With the cold sure to return soon, we’ll remember the feel and taste of our brief trip to the tropics.

Age Related Macula Degeneration – AMD

 

Age related macula degeneration (AMD) is a very common cause of blindness amongst the elderly population. Utilizing US census data physicians have estimated by 2020 almost 3 million people were likely to develop AMD. Constant research is occurring to search for more advanced therapies to treat this condition.

AMD is often divided into wet and dry. Dry macula degeneration is far more common. Its presence is dedicated by a dilated eye exam. Wear and tear changes build up in the very metabolically active macula (the center part of your vision) at the back of the eye in patients over 50 years of age. Some AMD patients have genetic predispositions to developing their disease. Other patients have modifiable risk factors that they can control to help slow the progression of their condition. The most important of these is smoking, as smoking is known to accelerate disease progression. Other factors in your control include maintaining good blood pressure and exercise.

Wet AMD occurs when new blood vessels grow underneath the retina. These leak fluid and bleed potentially causing rapid changes in central vision. Thankfully treatment of this condition has been revolutionized by injections delivered inside the eye painlessly. In many cases sight can be preserved with prompt treatment.
Historically, only destructive laser treatments were available that attempted to limit disease progression of wet AMD. Research showed that immature new vessel networks like those found in wet AMD need a biochemical called vascular endothelial growth factor (VEGF) to grow and thrive. Originally used for colon cancer, Avastin was one of the first anti-VEGF to be injected into eyes. The results were a dramatic reduction in activity of the new blood vessels networks, limiting their bleeding and fluid leakage and either restoring or preserving vision in a lot of patients. Now there are 2 other anti-VEGF medications available to use in addition to Avastin. Choice is physician dependent and good arguments can be made to select all three.

If you are identified as having wet AMD you will typically be recommended to receive monthly treatments by your retina doctor until your disease is under control. At this point many physicians extend treatment, this attempts to reduce treatment burden whilst keeping the eye safe. A lot of patients can be safely extended, some have new vessel networks that need more medication to treat, and cannot safely be extended. In the future sustained release medications may become available reducing treatment burden for many patients.
Developments in AMD are occurring all the time, new ways to monitor for progression (including home monitoring), new technology to detect wet AMD earlier, and in the future surgical intervention with stem cell therapies are all in progress. If you are older than 50 and have a family history of AMD talk to your eye care provider about getting screened for AMD.

 

Henry Holt, M.D.

1801 N. H. Medical Park Drive

Wilmington, N.C. 28403

Myopia and the Macula

Grid representing normal and abnormal macula. Description in the text.

Nearsighted individuals can develop problems in the center part of the vision. Very nearsighted individuals can develop thinning in the macula which is the center part of the retina. The macula is necessary for our finest detailed vision. Sometimes the thinning can disturb one of the layers of the retina which functions as a barrier between the underlying blood vessels in the choroid and the retina itself. Just like cracks in a pavement these thin areas can grow ‘weeds’ (new blood vessels). In fact a lot of pathologies in the macula that we treat have as there common path new blood vessel formation. Wet macular degeneration patients being the obvious example, here new blood vessel formation results from progressive degenerative change where age is the greatest risk factor.

The good news for myopic individuals is oftentimes their prognosis is better for their macula degeneration compared with their wet AMD counterparts. Patients with myopic choroidal neovascularization (new blood vessel formation or cnv) may experience distortion or a blur in their central vision. Oftentimes patients in this situation are extremely sensitive to any changes in their vision. If a patient has myopic CNV the standard of care is intravitreal medications (medications delivered inside the eye). Thankfully myopic patients often respond very well to treatment and can continue to enjoy good central vision for a long period of time. If you are extremely nearsighted it is important to get regular eye checks and if your ophthalmologist suspects myopic macular degeneration a retina specialist evaluation is always reasonable.

Henry Holt, MD
1801 N.H. Medical Park Drive
Wilmington, N.C. 28403

HURRICANE FLORENCE CLOSING

Due to the projected impacts from Hurricane Florence, Retina of Coastal Carolina’s Wilmington office will close at noon on Wednesday, September 12 and remain closed Thursday, September 13 and Friday, September 14. Our location in Jacksonville will remain closed through Monday, September 17. Please check our website for updated closing information. Our answering service can be reached by calling our main number (910) 254-2023.

Myopia – Retina Pathologies and Treatments

 

 

Diagram of peripheral retinal pathology showing retina atrophies, larger blood vessels, vitreous gel becoming more liquid and contracting away from the retina causing holes.

Should everybody with peripheral retinal pathology be treated?

This is controversial. The best data that we have would indicate it is reasonable to observe a lot of peripheral retinal pathology as the amount of subsequent retinal detachments are infrequent therefore one would have to treat a lot of patients to prevent one retinal detachment. However if you ask any retinal surgeon which they would prefer to treat; an atrophic hole with laser in the office or a retinal detachment in the operating room I know which one they would opt for!

So how do we decide?

I tend to treat patients that are symptomatic with flashing lights, or who have had a retinal detachment in the other eye, or who have a strong family history of retinal detachment. The risk of laser is minimal so I also offer each patient with peripheral pathology the option of prophylactic laser. Regardless of the decision to treat or observe nearsighted individuals should follow regularly with an ophthalmologist. And those that have peripheral retinal pathology should see a retina specialist once a year.

Henry Holt, MD
1801 N.H. Medical Park Drive
Wilmington, N.C. 28403

Myopia and the Retina

Diagram showing light rays converging at a point before the retina, and therefore out of focus

Myopia is a refractive state where the light entering the eye is focused naturally before the retina. It can either be refractive which is often due to the shape of the cornea, or it can be axial which is related to the length of the eye. Most people in a retinal office have axial myopia. Their eye is longer than average. As a consequence the retina is thinner than average. This can cause a number of different issues.

In the periphery degenerative holes or thin areas in the retina (lattice degeneration) can form leading to chronic retinal detachment. In the center of the retina, the macula, degenerative changes and thinning of the retina can lead to new blood vessel formation which can cause irreversible central loss of vision.

Who is at risk?

Although there is no definitive cutoff pathological myopia is defined as a prescription of greater than minus 8D. In practice anyone with myopia and a family history of retina issues should get screened by an ophthalmologist to ensure their eye is healthy.

Henry Holt, MD
1801 N.H. Medical Park Drive
Wilmington, N.C. 28403